I have also been quoted (and named, with my real name!) at BNET Pharma industry blog. I do have to agree with the sentiment. It would be a lot easier to sound sane if when I try to defend Pharma against claims of unethical practices if the industry I am trying to defend would just kindly stop engaging in them…

So the last post didn’t quite Pharm me all out as it was supposed to, so here’s a few remaining links in my medical marketing and related sturf I’d like to purge from my chest before they become totally irrelevant:

So I guess I should make some self-apologetics, that my point has *not* been that Pharma is cute and cuddly and can always be trusted – c’mon they are industry – the wonderful Merck saga unfolds beyond just deceptive journals – this sort of awful ‘hit list’ language to “neutralise” and worse, “discredit”, critical doctors makes me cringe (and if you’re sick of hearing about Vioxx, you can get upset at Lilly’s innapropriate off-label Zyprexa marketing instead). There is nothing I can concoct to attempt to downplay the totally unethical nature of that sort of behaviour, to me it is indefensible. There are bad elements out there. Even if we rule the Vioxx shenanigans as an exceptional exception (which is the closest I can get to a defence) just take a look at the US statistics on Pharma fines and settlements made by over the last 9 years (and that just to the government, does not include private parties, class actions etc.)

Pharmaceutical companies are corporations. And yes, they are motivated by making money. And AFM is right, some guy in marketing will try to put that goal ahead of making quality medicines. But let’s remember that’s also what these companies are about making medicines. Medicines that help people. People do not get into this industry because they want to hurt people.

The authors have taken advantage of there being quite a lot of publicly available information on clinical trials these days (yes, it is there, if you know where to look¹) to amass a whole host of information on cancer vaccine clinical trials for a type of analysis known as data mining.

There own summary of the results reads:

This application enables rapid extraction of information about institutions, diseases, clinical approaches, clinical trials dates, predominant cancer types in the trials, clinical opportunities and pharmaceutical market coverage. Presentation of results is facilitated by visualization tools that summarize the landscape of ongoing and completed cancer vaccine trials. Our summaries show the number of clinical vaccine trials per cancer type, over time, by phase, by lead sponsors, as well as trial activity relative to cancer type and survival data. We also have identified cancers that are neglected in the cancer vaccine field: bladder, liver, pancreatic, stomach, esophageal, and all of the low-incidence cancers.

Two cool things I learned from the paper were: Vaccines for cancers have been in development since the 1970s, and melanoma has been the cancer studied most for a vaccine, even though the first ones out to market have been for cervical cancer (expect melanoma vaccines in the next 1-5 years?).

But as we are looking to shift this discussion towards the pharmaceutical industry, let’s look at who runs clinical trials (Pop up: Figure 2a).

Insight on SBS ran a televised forum on medical marketing practices in Australia about a month ago, but I’ve only just caught up and watched it – it’s still available online. The forum involved proponents from within the industry, key watchdog figures, specialists, general practitioners, medical students and a few patients/consumers.

The key thing everyone seems to want is transparency – including the pharmaceutical industry, if only to appease public concerns.

Unregulated pharmaceutical advertising looks like this

It was good to see a discussion that focused well on the situation here in Australia (i.e. no direct-to-consumer advertising, subsidised universal healthcare, and a strict marketing code of conduct by an industry body enforced by an independent review panel). The best points I feel were made by the professor who pointed out that there is no problem with transparency, but why are we singling out the medical profession and pharmaceutical industry? Why are we not as concerned about the links the industry has to politicians, or pharmacists*, or the influence created by sponsorship of mining, agricultural, tourism and other industries on their respective providers?

No industry is as regulated and scrutinised as our medicines industry. Yet, it continues to be criticised as not doing enough. Sure, the system is by no means perfect, breaches occur – but they are pulled up on breaches, punished, and those breaches are publicised (and as the Pfizer representative said, that hurts their public image much more than any fine). I would not like to silence the critics, as that is the only way we can improve this system. They made good points that I’ve already blogged about recently drug samples don’t help, and brand name reminders (no matter their value) influence doctors.

Some concerns though seem a bit silly. What is wrong with bringing doctors from overseas to talk about medical advances? And just as odd, what is wrong with a mere 3% of doctors being sponsored to go overseas to learn about medical advances? Do they think Australia should develop it’s medical knowledge in isolation from our neighbours and field leaders in the US and Europe?

And some were just based on pure inability to comprehend how industry works, or anti-industry sentiment. I’m sure one person brought up the low cost of medicine manufacturing per pill compared to per pill costs to the consumer (because that is the only cost the industry faces ever?).

Some things I would have liked to have seen discussed more (or at all):

Spokespersons from either medical education or advertising companies – the people who actually produce the marketing materials?

Education in university medical courses – are medical students in Australia trained to deal with industry?

Training given to industry representatives regarding the code of practice – why do breaches still occur if everyone knows the rules?

Those industry marketers not participating in the MA, who watches them?

More scrutiny on those outside of the industry – pharmacists, consumer products, CAM and others who make spurious health claims and marketing incentives outside of regulatory bodies?

The ghost writing issue (this was probably avoided due to the legalities surrounding the Merck/Elsevier case, or SBS just didn’t know about it)

*The “chemists” the crusie ship guy were on about, were more than likely street-pharmacists, or even pharmacy assistants, regarding sales of alternative medicines, vitamins and/or consumer medicines – absolutely nothing to do with prescription medicines. I wonder if they’ll do a similar special with the Pharmacy Guild?

Drugs are expensive. And even if in a country like Australia, universal insurance may mean that vital medicines are cheap for the end-consumer, somewhere someone has pay the full price (i.e. the government).

Because drugs are so expensive, many drug companies – particularly when releasing a new product, will offer “free samples”. Now these aren’t quite like a give-away taste-test counter like at the local deli – the drugs still need to be prescribed by the doctor to a sick patient – but the principle is the same. You try it, and if it works, hopefully you’ll buy the real deal.

Sounds great! Hospitals get free medicines. Doctors learn about new treatments. Patient receives expensive treatment cheaply. And Pharma makes a friend. Everyone is a winner! What’s not to love?

Now this may have been the story, even as close as the early 90’s, but I would just love to see someone try and slip cruise ship tour past Medicines Australia.

Now, quite possibly, Burrow could be talking about the non-prescription pharmacy market – all the front-of-store goodies including a lucrative boom of complementary and alternative supplements. And that is worrying – because these are still marketed as health products – and pharmacies are community health professionals that should take professional pride and responsibility to ensure that the products they supply are based on evidence-based claims of efficacy, not who took them to Cairns for the weekend.

The lesson I’d like to impart from this is just how well regulated the prescription medicines industry in Australia is compared to some other industries. It’s not perfect - people are always trying to push the boundaries - but there are well-intentioned guidelines put in place to protect to all stakeholders – industry, health care professionals and the patient/consumer from exploitation.

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